| Learning Objective #1: Discuss methodological issues in conducting a preliminary trial of maternal knee-chest posture | |||
| Learning Objective #2: Describe implications for nursing in postural management research and practice |
Background Postural management is a clinical intervention intended to promote cephalic version of breech presentation in order to avoid maternal-infant morbidity and mortality. Research has been inconclusive; therefore, postural management is not an evidence-based practice. Previous research reports provided insufficient discussion of methodological limitations to guide further, more conclusive research.
Purpose This oral presentation aims to 1) discuss methodological issues in conducting a preliminary trial of maternal knee-chest posture and 2) describe implications for nursing in postural management research and practice.
Theoretical framework Postural management of breech malpresentation is based on Andrews' theoretical framework of maternal postures for fetal malposition.
Methods A randomized controlled trial at 3 sites in the Northeast US required a purposive sample of 256 women at 34-38 weeks gestation to detect 15% more versions from posture in a test of two proportions with 80% power, alpha = 0.05. Procedures are reported for recruitment, consent, randomization, teaching the theory-based postural intervention, follow-up, and data collection.
Findings Twenty-five women were recruited in 2 years. Slow accrual signaled the need to terminate the original trial to scrutinize research methods. Methodological limitations included statistical invalidity, problems underlying slow accrual, off-site ultrasound diagnosis, site employees as recruiters, and documenting dose of posture.
Conclusions Nursing research: Pilot studies are needed to investigate feasibility and improved methods for testing a theory-based postural intervention. Practical suggestions are given to decrease threats to internal validity in a trial of maternal knee-chest posture. Nursing practice: Nurses and midwives may advise pregnant women with breech presentation that postural management is not substantiated as an evidence-based practice. Providers and women are encouraged to participate in this clinical research.